Endoluminal repair of abdominal aortic aneurysm - contemporary Australian experience

Abstract

Objective: An audit was established in November 1999 by the Australian Government Department of Health and Ageing to determine the mid- to long-term safety and efficacy of endoluminal graft repair (ELG) of abdominal aortic aneurysm (AAA). The audit has been undertaken by the Australian Safety and Efficacy Register for New Interventional Procedures—Surgical (ASERNIP-S). This study reviews contemporary Australian practice, based on audit data supplied to ASERNIP-S. Design of study: This study is a prospective voluntary register (audit) of Australian data obtained from the private and public sector. Data were collected for ELG repairs performed between 1 November 1999 and 16 May 2001. Follow-up is continuing. Results: Seventy-nine vascular surgeons have contributed data on 950 patients (816 male, 134 female, of median age 75.5 (range 36–94)). The mean aneurysm size was 57.5 mm (±10.2) and 44% of procedures were performed on aneurysms less than 55 mm in diameter. Fifty four percent of patients were considered suitable for open repair. Most ELG procedures were performed in an angiography or endovascular suite, under general anaesthetic using an open technique via the femoral arteries. Perioperative mortality was 1.7%, mostly from cardiac causes. Prior to discharge 7.2% of patients experienced an endoleak and 18.6% had systemic complications. The average length of stay was 7.4 days (median 5 days). Unsuccessful exclusion of the aneurysm occurred in 6.7% of cases. Conclusions: Endovascular repair of AAAs is a well accepted procedure and is performed by the majority of vascular surgeons in Australia. Australian surgeons are taking a rather aggressive approach to the management of aortic aneurysms, particularly in the moderate to higher risk patient groups. Mortality rates are low, given the elderly population in question and morbidity rates acceptable. ASERNIP-S is continuing to collect follow-up data for this patient cohort.